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Cancer is diagnosed in 1600 children each year in the United Kingdom, and for teenagers cancer is the leading cause of death after accidents (unintentional injury, including road traffic incidents). The five year survival rate has improved over recent decades, from 30% to 80%; this increased survival has led to a rapidly increasing population of adult survivors, with an estimated 33 000 childhood cancer survivors now living in the UK.1 These survivors have higher premature death rates than the general population and are at increased risk of a range of physical and psychosocial problems.2 Late effects of treatment may occur soon after the treatment ends or many years later. Healthcare practitioners need guidance about potential late effects and the lifelong needs of survivors of childhood cancer. This article summarises the most recently updated recommendations from SIGN.3 SIGN recommendations are based on systematic reviews of best available evidence. The strength of the evidence is graded as A, B, C, or D (figure⇓), but the grading does not reflect the clinical importance of the recommendations. Recommended best practice (“good practice points”), based on the clinical experience of the Guideline Development Group, is also indicated (as GPP). The group appraised the current evidence for new or completely revised sections on subsequent primary cancers, fertility, cardiac and bone health, and metabolic effects; for the remaining sections the group did not re-appraise the original supporting evidence. Fig 1 Explanation of SIGN grades of recommendations ### Subsequent primary cancers (all new recommendations)